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After exposure to disaster, mass violence, or other adverse events, psychosocial support is usually provided to assist and calm those who were affected, reduce the sense of ongoing threat, foster connection and resilience, and hopefully mitigate the risk for long-term consequences on individuals, families, and communities. Psychological first aid (PFA) has become a widespread intervention of choice in these settings, but because of the chaotic nature of these environments and the need for a flexible, person-centered approach, definitive research support for its effect is still largely absent. 
With this imbalance of popular support for PFA and scant evidence of outcome data in mind, we conducted a systematic review examining PFA’s efficacy in improving the well-being of individuals exposed to potentially traumatic events. It included peer-reviewed studies that evaluated participant mental health and psychosocial well-being following PFA or PFA-adapted interventions (published in English before March 9, 2021). 
Of 9,048 potentially eligible citations, twelve studies (only one randomized controlled trial) with a total of 1,437 participants met criteria for final analysis. The findings from all studies suggested a generally positive impact of PFA in both youth and adults, with most reporting reduced anxiety, depression, posttraumatic stress disorder (PTSD), and distress, and improved mood, feelings of safety, connectedness, and sense of control. However, inconsistent intervention components, inadequate evaluation methodologies, and high risks of bias within the reviewed studies limited the ability to evaluate PFA’s efficacy. 
This review concluded that while PFA components appear to do no harm and may improve well-being, because of the limited nature of the evidence, inconsistent intervention components, insufficient evaluation methodologies, and high risks of bias within studies, further research is needed. Large crises, such as the current COVID-19 global pandemic, provide unique opportunities to focus responders, leverage new funding, and build an evidence base to guide response efforts. While the chaotic nature of these types of events, combined with the flexible PFA approach, make research challenging, if future studies can more effectively evaluate PFA’s effects, they can not only move the field forward but improve our chances of mitigating some of the negative psychosocial outcomes from adverse events. The time to fund the work is now.

Target Article

Hermosilla, S., Forthal, S., Sadowska, K., Magill, E., Watson, P., Pike, K. (2022). We Need to Build the Evidence: A Systematic Review of Psychological First Aid. Journal of Traumatic Stress, accepted August 18, 2022. DOI: 10.1002/jts.22888.

Discussion Questions

  1. Current evidence for PFA is limited, how can we as a field build more reliable, replicable, rigorous evidence around PFA efficacy?
  2. What are some challenges involved with building the evidence around mental health interventions without compromising public trust in providers?
  3. How do mental health professionals balance guidance to donors and public policy makers when recommending population-based interventions?
  4. How can researchers increase the rigor of intervention evaluations in complex, challenging, post-disaster settings?

About the Authors

Sabrina Hermosilla,
 PhD, MIA, MPH, MS (she/her) is an Assistant Professor in the Heilbrunn Department of Population and Family Health at the Columbia University Mailman School of Public Health. Her research applies epidemiologic principles and methods to study social determinants of mental health and psychosocial outcomes in complex global settings. Dr. Hermosilla can be contacted at sh2405@cumc.columbia.edu or @HermosillaSabri.

Sarah Forthal, MPH
is a doctoral student in the Department of Epidemiology and fellow in the Psychiatric Epidemiology Training Program at the Columbia University Mailman School of Public Health. She can be contacted at slf2142@cumc.columbia.edu.

Karolina Sadowska
is a MD student at Weill Cornell Medical College. She is interested in combining principles of pragmatism and evidence-based medicine to address mental health needs of distinct patient populations. She can be contacted at kas4022@med.cornell.edu.

Patricia Watson, Ph.D. is a clinical psychologist working for the National Center for PTSD (NCPTS).  She is a co-author of the NCPTSD/NCTSN PFA and Skills for Psychological Recovery (SPR) Manuals and the Stress First Aid (SFA) self-care and coworker support model for those in high stress occupations, as well as co-editor of three books on disaster behavioral health interventions.  Dr. Watson can be contacted at patricia.j.watson@dartmouth.edu

Elizabeth Magill
(she/her) is a MD/MPH student at the Icahn School of Medicine at Mount Sinai. Her research and clinical experience focuses on cross-cultural psychiatry and global implementation of evidence-based psychological treatment methods. She can be contacted at elizabeth.magill@icahn.mssm.edu.

Kathleen M. Pike
(she/her) is Professor of Psychology at Columbia University Irving Medical School. She serves as the Director of the Columbia - WHO Center for Global Mental Health. Her research and policy experience focus on translating science into practice to improve public mental health in a wide range of contexts around the globe.